Paper 21: Functional Outcomes of Primary Ulnar Collateral Ligament Repair with Internal Bracing in Athletes

Objectives: The ulnar collateral ligament (UCL) is the primary restraint to valgus stress in the elbow. Injury to this ligament can occur in the setting of acute trauma as well as chronic overuse as seen in baseball players and other overhead athletes. Injury to the UCL continues to be a major source of morbidity in overhead-throwing athletes, with the incidence of UCL tears increasing dramatically over the past 15 years. UCL reconstruction using palmaris longus or hamstring autograft (also known as Tommy John surgery) has been considered the gold standard for the surgical treatment of symptomatic UCL injuries in overhead athletes for decades. Recently, there has been a renewed interest in UCL repair. In 2016, Dugas et al described the novel use of a collagen-dipped internal brace to augment UCL repair with encouraging biomechanical results from a cadaveric study. To date, only two studies have reported outcomes for this novel approach to UCL repair with internal brace (IB) augmentation, both with encouraging results. It is thought that the main advantages of UCL repair with IB augmentation compared to UCL reconstruction are comparable return to sport rates with a more rapid postoperative recovery, as well as restoration of normal anatomy that eliminates the need for an autograft and the associated complications of graft harvesting. Given the paucity of data examining this new surgical approach, this study seeks to add clinical outcome data for UCL repair to the scientific literature. The goal of this project is to evaluate functional outcomes following primary ulnar collateral ligament repair using internal brace augmentation and to describe new advancements in the surgical technique for this procedure. Methods: Approval was obtained from the Columbia University Irving Medical Center Institutional Review Board. A retrospective review of the electronic medical records of all consecutive patients who underwent medial UCL repair with internal brace augmentation between 2016 and 2022 was performed. All procedures were performed at a single tertiary institution and all patients were under the direct medical care of the senior author. Only patients with a focal UCL injury, such as a distal or proximal avulsion tear, were selected for UCL repair with internal brace augmentation. Evidence of chronic attritional disease, including calcification on MRI, or extensive ligamentous injury were contraindications to UCL repair. Additionally, only patients undergoing prim